Comparison of opera / mews scorings and imaging findings in patients applying to the emergency department with dyspnea during the COVİD-19 pandemic period

The American Thoracic Society defines shortness of breath as "a person's subjective experience." It has been predicted that it may result from interactions between multiple physiological, psychological, social and environmental factors and secondary physiological and behavioral responses. On March 11, 2020, the World Health Organization (WHO) declared the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic, due to the number of cases that started in China and is constantly increasing all over the world. In our study, it was aimed to compare the differences and similarities between the OPERA scoring, MEWS scoring and imaging findings in patients who applied to the emergency department with shortness of breath during the COVID-19 pandemic, and to ivestigate the findings regarding the diagnosis, prognosis and survival of the patients. Methods: Our retrospective cross-sectional study included 271 patients who presented to a university emergency department with dyspnea. The MEWS and our own developed OPERA scores of the patients included in the study were compared in terms of need for intensive care and mortality. In addition, demographic characteristics of the patients such as age and gender, known chronic diseases, the time of onset of the complaint at admission, vital signs at the time of admission to the emergency department, hemogram parameters, biochemical parameters, serological tests, coagulation parameters and detailed findings of computed tomography (CT) were scanned. Patients were analyzed in terms of their diagnosis, need for intensive care, and two-month survival. Results: In our study, the diagnoses of the patients who presented to the emergency department with dyspnea were 83 (30.6%) COVID-19, 30 (11.1%) decompensated heart failure, 46 (17.0%) other lung infections, 17 (6.2%) COPD attacks, 11 (4.1%) malignancies, 6 (2.2%) pulmonary embolism and 78 (28.8%) other. The two-month survival of the patients and the need for intensive care were compared with the CT findings. It was determined that the need for intensive care and mortality were higher in cases with bilateral (86.2%) and patchy (61.5%) involvement according to the lesion distribution and involvement type. Two-month survival was lower in the pictures accompanied by air bronchogram (26.2%), consolidation (31%), lymphadenopathy (71.4%) and pleural effusion (57.1%), and the differences were statistically significant (p<0.001). The vital signs of the patients at the time of admission to the emergency department were evaluated with the Modified Early Warning Score (MEWS). When the value of 4 was determined as the limit for the MEWS score, 21 (14.1%) patients with a MEWS score of <4 were admitted to the intensive care unit, and 48 (39.3%) patients with a MEWS score ≥4. Again, 9 (6.0%) of the patients with a MEWS score of <4 were mortal, while this number was found to be 34 (27.9%) in those with a MEWS score of ≥4, and the difference was statistically significant (p<0.001). In the scoring system we developed, the patient's Oxygen saturation, Predisposing factors (Additional Diseases), Effusion, Radiological findings and Age were evaluated. We named our scoring system as OPERA by taking the first letters of the factors in English. As a result of the ROC analysis applied for this scoring table, the cut-off point was accepted as 6. When the hospitalization status of the patients in the intensive care unit was examined in terms of the OPERA score cutoff value, 27 (12.8%) patients with an OPERA score were <6, while this number was 52 (37.7%) in those with ≥6. When the mortality numbers were analyzed according to the OPERA score cut-off value, 4 (3.0%) of the patients with OPERA score <6 were mortal, while this number was 39 (28.3%) in those with OPERA score ≥6, and the differences were statistically significant (p<0.001). While the sensitivity of the MEWS score was 69.6% and specificity 63.4% in the patients who needed intensive care, the sensitivity was 79.1% and the specificity was 61.4% in the mortal group. In the OPERA scoring system, the sensitivity was 75.4% and specificity 57.4% in the patients who needed intensive care, while the sensitivity was 90.7% and the specificity 56.6% in the mortal group. Conclusion: In our study, it has been shown that an early idea about the diagnosis and prognosis can be obtained according to the complaints, vital parameters and tomography findings of patients who applied to the emergency department with shortness of breath during the pandemic period. Compared to MEWS, our newly developed OPERA scoring was found more sensitive with a mortality rate of 90.7% in patients requiring intensive care, with a mortality rate of 75.4%. More comprehensive studies need to diagnosis, treatment and prognosis of COVID-19.